Tricuspid valve infective endocarditis is a known complication of injecting drug use (IVDU) and is said to be rare in Africa. The most common etiological microbial agent of infective endocarditis (IE) in IVDU is Methicillin sensitive Staphylococcus aureus. Antibiotic treatment should start immediately after blood cultures have been obtained once IE is diagnosed. Treatment of IE in patients with IVDU is more difficult, and has a high recurrence rate due to medical non-compliance and continuing IVDU. The status of IVDU in Ethiopia is not known. The updated strategies of diagnosis and treatment as well as prognosis of IE in an IVDU patient who presented with respiratory symptoms and later diagnosed with TV endocarditis will be discussed.